Organization
DIPAUL DENTAL, PC
Active
Other names
Aspen Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KIM VAN CAMP (PROVIDER ENROLLMENT SPECIALIST)
(315) 454-6000
Entity
Organization
Contact information
Practice address
2219 PAUL BUNYAN DR NW STE 6-7, BEMIDJI, MN 56601-6188
(218) 751-2659
(218) 751-1806
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
(866) 273-8204
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13499
MN
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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